Geographic Variation And Socio-Economic Correlates Of Heart Disease Death Rates In West Virginia, 1999-2012

摘要

This paper examines the spatial pattern of heart disease death rates in the general population in West Virginia between 1999 and 2012. METHODS: Tertiles of low, medium, and high rates are derived for heart disease death rates for the counties and choropleth maps are created to depict the changes in the spatial distribution of counties with low, medium, and high rates over the study period. Correlation analyses are performed to explore the association between the outcome variable and selected socio-economic variables. RESULTS: Overall, the heart disease death rates declined over time in the state. While the number of counties with high death rates decreased during the study period, the counties with low rates increased in number. The analyses show that the heart disease death rates are significantly associated with educational attainment, household income, and lack of health insurance. CONCLUSION: The between-county differences in the heart disease death rates suggest that the underlying factors and the associated mortality burden have varying impact on West Virginia communities. While the correlation results indicate the significance of the county level socio-economic environment, research is needed to investigate this association at the individual level in the state. INTRODUCTION Despite the steady decline in heart disease-related deaths in the United States since the 1960s (Pickle and Gillum 1999; American Heart Association 2010), heart disease remains the leading cause of death in the nation (Mini?o et al. 2011). The financial burden of coronary heart disease, the most common type of heart disease, was projected to cost the nation about $151.6 billion in 2007 (Rosamond et al., 2006) and about $108.9 billion in 2010 (Heidenreich, et al., 2011). The West Virginia Department of Health and Human Resources (WVDHHR) reports that in 2007, heart disease accounted for 5234 deaths in the state, constituting an age-adjusted mortality rate of 230.2 per 100,000 (WVDHHR, 2011). Although heart disease accounts for the largest proportion of cardiovascular as well as all deaths in the state, little is known about the evolving spatial pattern of its rate of occurrence. Changing patterns of high or low heart disease mortality rates across the state may be telltales for the spatial dynamics of underlying factors. For instance, Peter et al. (1996) find that a north-south trend in cardiovascular and ischemic heart disease mortality in Eurasia mirrors the spatial pattern for body mass index and blood pressure; and Taylor et al (1999) demonstrate that urbanized areas have higher heart disease mortality rates than remote, rural areas. In recent studies, certain socio-economic factors have also been found to be significantly associated with heart disease mortality. When comparing the mortality experience of Scottish postcode sectors, McLoone and Boddy (1994) found that death rates from ischemic heart disease and carcinoma of the lung and bronchus at ages 40-69 were lower in all deprivation categories in 1990-92, and that more affluent areas experienced greater reduction in the death rates. They also found that the difference in ischemic heart disease death rates between deprived groups and the affluent increased over time. In analyzing the geographic variation in cardiovascular disease morbidity and mortality in public health units in Ontario, Djietror (2003) found that average dwelling value (which, he notes, is an indicator of permanent wealth and social status) is negatively associated with the rate of ischemic heart disease mortality. Djietror and Inungu (2008) analyzed spatial patterns and covariates of heart disease death rates in Michigan counties and show that poverty rate and lack of health insurance is positively associated with heart disease death rates while educational attainment and household income are inversely associated with the death rates. Loughnan et al (2010) demonstrate that both age and socioeconomic inequality contribute to